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Why many entrepreneurs are privatelysuffering, and what to do about it

BY BRYAN NEUBERG ON FEBRUARY 20, 2013

The startup community has been jolted by a spate of suicides: Ilya Zhitomirskiy at the ageof 22, wunderkind Aaron Swartz, and most recently eco-mom’s founder Jody Sherman. Thestartup community is grappling with challenging questions about the toll thatentrepreneurship can have on founders.

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Paul Graham was once asked if he chooses stable or crazy applicants for Y Combinator. Hisreply: “There’s some people who are crazy, who are basically manic depressives andsomehow manage to keep the depressive part to a minimum. Those are good. But hearingvoices kind of crazy? Not good.”

Graham isn’t talking about full-blown manic depression, which can include hallucinationsand psychotic delusions. He is describing what UCSF’s Michael A. Freeman M.D., apsychiatrist and former VC startup executive, calls “soft bipolar.” Soft bipolar is a distantcousin to manic depression that often includes mild depressive dips and a light form ofenthusiastic, energized, creative mania, called hypomania.

Dr. Freeman explains: “Hypomania can give entrepreneurs significant advantages. Itincludes elevated mood, expansive creativity, and an increased ability to tolerate risk. Softbipolar entrepreneurs can be visionary, highly self confident, persuasive, energized, andboundlessly enthusiastic about the companies they are building.” Think of hypomania as akind of “success gene.”

Hypomania can also be the “wiring” that helps make some entrepreneurs successful. In thebook “The Hypomanic Edge: The Link Between (A Little) Craziness and (A Lot of) Successin America,” psychologist Dr. John Gartner lists well-known figures like Ted Turner,Andrew Carnegie, and Craig Venter, all of whom seem to display these traits.

I won’t speculate why the three beloved entrepreneurs I listed above died. In general,though, many believe that running startups can drive people to experience intense ups anddowns. While this is true, it’s often the other way around: People in the bipolar spectrumare attracted to entrepreneurship. Building businesses can be a great way for hypomanicentrepreneurs to apply their energy and creativity.

Some people are more vulnerable to mood fluctuations and can also experience episodes ofdark depression that may include feelings of hopelessness, irritability, fatigue,concentration problems, and feelings of worthlessness. People naturally don’t likediagnoses. Who likes being boxed in? While some of the soft bipolar traits can primepeople for success, we need to acknowledge that the downsides confer significant risk, bothto entrepreneurs and their companies. If we as a community can overcome the stigmaassociated with mental health conditions enough to look at the suicides of our colleaguesthrough this filter, perhaps we can begin to create awareness of, and access to possiblecures.

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It’s not just about preventing people from killing themselves. When people understand howthey are wired, they can optimize their performance, increase the odds of buildingsuccessful companies, and realize greater returns for the investors who help launch newideas into the world.

As an executive coach and managing partner of a firm, I have clocked more than 5,000hours with business leaders of many stripes. For most of our clients, we teachstraightforward leadership skills and help them scale their companies. Over the years,however, I have helped many on the soft bipolar spectrum.

For those who are mostly hypomanic, they need support in checking the “irrationalexuberance” that can put their companies at risk. They need to engage in calming activitieslike walking, meditating, and ensuring that they abate the insomnia that naturally comeswith an active mind. They also need cofounders, employees, and advisors who are willing tochallenge the feasibility of implementing some of their wild ideas. Those who experiencemild depression must train themselves to follow exercise regimens, spend time with lovedones, and learn how to manage feelings of self doubt and negative thinking. And for thosewho suffer from bouts of chronic depression, the right medications and evidence-basedtherapies can be life changing.

That said, I believe the pharmaceutical industry pushes this country to be overmedicated.But I have seen great leaders, who are privately suffering, become depression-free whenthey get on the correct dose of the right medications, coupled with reframing negativethinking and making the right behavioral and life-style changes. I emphasize the rightmedications, because the wrong ones can be devastating.

There’s a lot to be done, though. Dr. Freeman cautions that many general physicians andpsychiatrists don’t even know about soft bipolarity. If they prescribe traditionalantidepressants, these medications can be like poison to people who are soft bipolar bymaking their mood swings worse.

As a community, we need to hold a nuanced view about the mind of the entrepreneur. Manyare a breed unto themselves, born with a wiring that endows them with special abilities.With that sometimes come downsides.

As Steve Jobs once said, “Here’s to the crazy ones… because the ones who are crazy enoughto think that they can change the world, are the ones who do.”